Focus On... Falls Prevention and Home Modification This publication is copyrighted by the American Occupational Therapy Association and is intended for personal use. None of the information can be copied or shared in any format without permission from AOTA. Contact [email protected] to request additional use. Focus On... Falls Prevention and Home Modifications reventing falls and aging in place—these are two of the biggest concerns for Americans as they age, and occupational therapy researchers, clinicians, and educators are doing a great deal to help, as detailed in the articles and other materials brought Ptogether here as part of AOTA’s “Focus On” edition on falls prevention and home modifications. Along with fact sheets, a how-to guide, and links to evidence supporting occupational therapy’s key role in these areas, the articles and resources here cover the many types of community-based programs that occupational therapy practitioners can help create to help people prevent or reduce falls, provide advice on evaluating homes for poor lighting and other hazards, and offer profiles of occupational therapy practitioners working with other rehabilitation professionals and home contractors to allow residents to engage safely and as conveniently as possibly in valued occupations.. Reducing Fall Risk: Home Modification and the Therapeutic Value A Guide to Community-Based Programs of Advocacy Elizabeth W. Peterson John Hurtado OT Practice, September 12, 2011 OT Practice, September 26, 2011 Standing Tall: A Self-Management Approach Occupational Therapy and Rebuilding Together: to Fall Prevention Intervention Working to Advance the Centennial Vision Elena Espiritu Wong Claudia E. Oakes and Cathy Leslie OT Practice, September 9, 2013 OT Practice, September 10, 2012 Light the Way: Providing Effective Home Modifications Occupational Therapy Gives Rebuilding Together That for Clients With Low Vision “Little Sweetness” Debra Young Andrew Waite OT Practice, September 10, 2012 OT Practice, September 9, 2013 Bathroom Safety: Environmental Modifications to Caroline Bartlett Crane’s Everyman’s House: Enhance Bathing and Aging in Place in the Elderly Historical Home Design and Home Modification Today Tacy Van Oss, Michael Rivers, Brianna Heighton, Cherie Macri, Carla Chase and Suzanne Roche and Bernadette Reid OT Practice, September 26, 2011 OT Practice, September 10, 2012 AOTA Official Document: AOTA’s Societal Statement on Home Teams: Practitioners Partner With Contractors for Livable Communities Home Modifications Andrew Waite AOTA Fact Sheet: Occupational Therapy and the OT Practice, September 26, 2011 Prevention of Falls Home Sweet Home: Interprofessional Team Helps Older AOTA Fact Sheet: Home Modifications and Occupational Adults Age in Place Safely Therapy Allysin E. Bridges, Sarah L. Szanton, Allyson I. Evelyn-Gustave, Felicia R. Smith, and Laura N. Gitlin AOTA Tip Sheet: Remaining in Your Home as You Age OT Practice, September 9, 2013 AOTA Tip Sheet: Helping Your Older Parents Remain Whose Safety Is It Anyway? Evaluating Outcomes at Home of Home Modifications Claudia E. Oakes Falls Prevention Presentation How-To Guide Home & Community Health SIS Quarterly Newsletter, June 2013 For More Information: AOTA Evidence and Research Resources Note: At the time individual items were published, prices and products were up to date. Copyright © 2014 The American Occupational Therapy Association, Inc. Please check http://store.aota.org or www.aota.org for current information. Reducing Fall Risk A Guide to Community-Based Programs ELIZABETH W. PETERSON ccupational therapy Community-based programs can draw from participants’ practitioners’ commit- ment to fall prevention everyday experiences to help create individualized fall increasingly involves linking older adults to com- prevention strategies. Omunity-based programs designed to reduce fall risk. This trend is fueled by improved availability of these programs the psychological and physical energy and apply fall risk management skills as well as high demand. Community- needed to begin fall prevention efforts that can be generalized to a variety of based programs can extend benefits in earnest. situations. These programs address associated with clinical intervention. The dynamic nature of occupation diverse factors contributing to falls Many older adults are seen by occupa- requires older adults to routinely make and help participants understand how HOTO tional therapy practitioners in tradi- good activity choices to avoid falls. risk factors work together to increase P tional medical or home care settings Therefore, community-based programs the chance of falling. This is important immediately after a fall-related injury— that draw from participants’ day-to- because although falls can be caused a time when many clients prioritize day experiences to help them create by “stand alone” problems such a heart managing immediate self-care needs individualized fall prevention strategies arrhythmia, most result from interact- over learning about longer-term fall are valuable. Programs such as Matter ing risk factors. These risk factors may H © ISSAURINKO / ISTOCK P prevention strategies. Once clients’ of Balance1–2 and the Stepping On Falls be physical, environmental, behavioral, medical status and lives have stabilized, Prevention Program (Stepping On),3 or attitudinal, as in the case of an older PHOTOGRA however, they are more likely to have foster participants’ ability to develop adult who develops a fear of falling. The OT PRACTICE • SEPTEMBER 12, 2011 15 influence of fear of falling on fall risk Otago. Because occupational therapists (including occupational therapists) should not be underestimated. Although were centrally involved in the develop- can use to evaluate clients’ fall risk and some concerns about falling are protec- ment of Matter of Balance and Stepping develop effective intervention plans. tive and keep a person from engaging On, expanded details of those programs Occupational therapy practitioners are in activities with demands that exceed are provided. uniquely prepared to contribute to fall abilities, research suggests that many prevention efforts due to their atten- people who are afraid of falling enter a A GROWING PUBLIC HEALTH PROBLEM tion to diverse influences on occupa- debilitating spiral of loss of confidence, Falls are a serious public health prob- tional performance13 and ability to use restriction of physical activities, physical lem in the United States and interna- a variety of intervention approaches. frailty, falls, and loss of independence.4–5 tionally. Approximately 30% of older These approaches range from preven- Further, these studies show that people adults (i.e., people aged >65 years) tion and remediation to modification who limit activity because of fear of living in the community fall each year,6 and disability prevention.14 falling are at particularly high risk of and the likelihood of falling increases becoming fallers.4–5 rapidly with advancing age.7 MATTER OF BALANCE Community-based exercise pro- For healthy and active older adults, Matter of Balance is a multicomponent, grams designed to reduce fall risk are a serious fall-related injury can be the group intervention explicitly aimed increasingly available to older adults introduction to old age. For more vul- at reducing excessive concerns about in the Unites States. It is important to nerable seniors, falls can be a marker falling and activity avoidance.2 The pro- recognize that Stepping On and Mat- for frailty and the result of a larger geri- gram was developed by an interdisci- ter of Balance complement exercise- atric syndrome that ultimately leads plinary team at Boston University that based interventions because they help to disability, dependence, and death.8 included an occupational therapist, participants develop attitudes that sup- The financial costs associated with falls and has been evaluated through two port engagement in healthy behaviors, are staggering, with the direct medical randomized trials that used health care emphasize the importance of exercise costs of fall injuries totaling more than professionals as interventionists.1–2 to fall risk reduction, and include exer- $26.3 billion annually.9 Both trials demonstrated the program’s cises during most program sessions Both single factor interventions ability to accomplish its primary objec- (see Table 1 on p. 17). The Centers for (e.g., exercise programs; withdrawal tive, which is to increase falls self- Disease Control and Prevention (CDC) of drugs for improving sleep, reduc- efficacy (i.e., perceived self-efficacy has undertaken a major initiative to ing anxiety, treating depression) and or confidence at avoiding falls during AGING Y disseminate two exercise programs: the interventions with multiple compo- essential, nonhazardous activities of TH L A 15 E nents are effective in preventing falls daily living). In the most recent trial, H Tai Chi: Moving for Better Balance Program, and the Otago Exercise among community-dwelling older there were significantly fewer recur- OR P F Programme (Otago), as well as Step- adults.10–11 Individualized evaluation rent fallers in the intervention group.2 RSHI E ping On. leading to identification of a person’s The conceptual model used in Mat- TN This article describes falls as a prev- unique fall risk factors is essential ter of Balance is based on the work of AR E P TH alent but preventable problem among to developing effective treatment Bandura, a leading social theorist, and F O 16 Y community-dwelling